Functional Test Report Installation Completion

Mechanical Alignment Test Status (Pass/Fail/NA)

Report Ref Number : 7982XR0096 / INSTALLATION / 180320 Tube Assembly Movement (Vertical, Rotation, Angulation, etc.) PASS
Hospital Information Wallstand Carriage Vertical Movement PASS
Hospital Name : RS Kedokteran Universitas TanjungPura Table movement (Vertical, lateral, longitudinal) PASS
Address : Jl. Prof DR H. Hadari Nawawi Pontianak Compression movement and force (mammo) NOT AVAILABLE
Testing Date : 18-Mar-20 Xray tube arm movement (Mobile xray and C-arm) PASS

Unit Information InSpec Functional Checks

Unit Type : XR-6000 VRS System Power Up and Console PASS
Subsystem Model No Serial No Tube Conditioning / seasoning PASS
Tabung 5331186 158333BC5 Collimator PASS
Table SGT-2 182911HL8 Tube Voltage (kV) Accuracy PASS
Wallstand SGW-2 182909HL2 Tube Current (mA) Accuracy PASS
Collimator XS-1A SA20190241 Exposure Time (S) Accuracy PASS
PDU SPV-1 182910HL0 Exposure mAs Accuracy PASS
Automatic Exposure Control (AEC) - Option NOT AVAILABLE
Automatic Brightness Control (ABC) - Option NOT AVAILABLE
Noise and Lag calibration (Fluoro) NOT AVAILABLE
Mechanical Installation (Installation) Status Accuracy of X-Ray Field and Light Field Alignment PASS
System Mechanical Installation PASS Centers of X-Ray Field and Image Receptor Alignment PASS
Fluoro Record (Fluoro and Cathlab) NOT AVAILABLE
Hospital Power and Grounding (Installation and Annual PM) DICOM configuration and Image transfer - Option NOT AVAILABLE
Measurement Minimum Maximum Average Collimator Light Timer PASS
R-S (V) 386 388 387 Image Quality PASS
S-T (V) 388 390 389
R-T (V) 388 390 389 Radiation Leakage Test
N-G (V) Room Radiation Leakage Test PASS
Grounding Resistance (ohm) 1
Feeder Wire Size on PDB (mm) 50mm Conclusion of Functional Check

Temperature and Humidity (Installation and Annual PM) The system unit meet GE specification
Rooms Temp (Max) (Celcius) Temp (Min) (Celcius) Hum (Max) % Hum (Min) %
EXAM Room 24 18 65 60 Recommendation
Technical Room
Operator room 22 18 65 60

Safety Check
System Level Safety Test Status (Pass/Fail/NA)
Patient Touch Leakage Test PASS Date : 18 Maret 2020
System Chasis Leakage Test PASS
Emergency Status Test PASS
Ground Continuity PASS
Door Switch PASS
Xray Warning lamp PASS
Deni Firmansyah ……………………………….
Team Leader PT. GEOI Ka.Instalasi RS/Klinik